Is there a field and a concept in the study of public policy for the effectiveness of health promotion?

Abstract

Criticism of common thought on politics is indispensable when pondering the interface established with academic knowledge, which is constructed on the grounds of the uncertainty of the sciences and of the dialectical interlocution between convergences and divergences in the formulation and/or reformulation of concepts, in addition to the construction of a possible field of studies on public policies and their applicability. In the context of health promotion, it is essential to disseminate the broad idea that this field cuts across the core human needs; therefore, promoting health nowadays presupposes understanding public policies and their constant conflicts and convergences in search of models that meet the intangible social demands. Because of this dual construction that originates from the common sense and the epistemic bulge, the study of public policy is not restricted to a single academic subject, which brings to the fore the importance of understanding the field as a constructor of academic knowledge in multiple subjects. This premise can be proven by the challenges in presenting theories, methods and tools exclusively designed to study the theme(1). This polarization has gained great importance due to the urgency of decision making by public managers and reverberates in current context of health education, particularly regarding its promotion. There has been an attempt to optimize “expertise” as one that is developed under the auspices of “best scientific evidence”. In this logic, if scientific evidence is needed for teaching in general, one can use syllogism and think that the same holds true for the teaching of public policies aimed at promoting health. However, questions about the teaching of public policies emerge in overwhelming ways and require reflection on the concepts inherent to the field in order to decide what to teach, how to teach and when to teach. The teaching of health promotion demands a discussion about the contradictions of the contexts and the particularities of the different territories found in the country, which makes its practice a challenge inherent in the current public policies(2). Considering the discourses that are so complex and paradoxical and at the same time transparent and tangible, it should be noted that discussing the plurality of contexts in this country is no longer enough; instead, it is necessary to dialog with the world scenarios that advance towards the reduction of social iniquities(3). It is important to mention Pierre Bourdieu, who argues that it is impossible to separate the values and representations that we have from the scientific ideals and that there are no disinterested choices. Additionally, as regards the concept of field, the author reports the presence of a “field of power”, like a “field of struggles”, which constrains those who are in it. However, the heterogeneity of the field gives rise to convergences and to the construction of differentiating edges, which enable other possible ideological encounters(4-5). With this in mind, the idea of what makes the study of politics, political science, welfare economics and public administration different should be conveyed. Even though they are related fields that fall under the public interest, they differ in their bases and their objectives. In order to do so, public policies should require the taking of practical actions, presented as positive actions, as opposed to omission, which results in inertia as a negative reaction to lack of proactivity(6). Based on this premise, competencies for health promotion must be built during professional training and should include the concepts of equity, social justice, ethics and individual autonomy in the multifaceted perspective intrinsic to the public health field(7). It should be noted that if a group of social actors has difficulties in understanding the concepts that surround it, it will be difficult to construct clear ideas on the topics that require theoretical and methodological densification to support new practices that redefine the “everyday lives”. So, the plural field of public policies gives way to subfields: political process – action that requires effort for its understanding due to its changing and inconstant aspect; analysis of policies – a theoretical necessity for a more accurate understanding of the possibilities that the field can bring about; and evaluation of policies – a funder of the correct answers and challenges of the concepts inherent to the theme denoting the reality experienced – but nevertheless lived. Therefore, the concepts of the political process in health promotion, as presented before, run through the time and can be conceived in the following question: what are we doing? The analysis of policies point to the future: what should we do? And, the past emerges in the evaluation of policies: what have we done? In the meantime, efficiency and effectiveness are embodied as attributions that public policies, with a health promotion bias, must have in order to minimally achieve objectives that prioritize collective needs over individual ones. With a view to understanding these constructions historically and redefine the current concepts about the field, Plato, Machiavelli, Thomas Hobbes, John Locke, James Madison, Adam Smith, and John Stuart Mill appear as essential readings for analyzing societies’ actions towards public policies in different scenarios and temporalities. Currently, public policies aimed at health promotion need to be guided by teaching and research that consider the social inequities present in the world in order to determine potential pathways for impacting health outcomes(8). After reflecting on the theme, we should ask ourselves: how can we take advantage of the concepts inherent to the field to reach the “optimal level” of public policies for health promotion? How is public policy concatenated with scientific tools in order to foster reflections on new practices? In the Brazilian scenario, how should public policies for health promotion be developed within a socially, administratively and financially weakened system? In the public health field, which is in continuous construction, such questions are complex and require us to understand that health policies cut across public policies. In addition, they are potent and provide possibilities to strengthen a national and public health system which proclaims the principles of universality, comprehensiveness, and equity. Based on the above, public policies focused on putting health promotion into effect are still a work in progress. The Brazilian Journal of Health Promotion stands out as a scientific journal that enables dialog on the theme between different fields of knowledge, highlighting the importance of these discussions in the Brazilian public health.